Dislocated Intraocular Lens

There are several options available to treat a dislocated intraocular lens (IOL).

What is an Intraocular lens?

An intraocular lens (IOL) replaces the original crystalline lens when a cataract is removed, and provides the light focusing function originally undertaken by the crystalline lens. When a cataractous or cloudy crystalline lens is removed during cataract surgery, the outer layer of the lens is left in place to support the IOL. If you imagine that a cataract is like a peanut M and M but that the candy coating is transparent, like plastic wrap, then during cataract surgery a hole is cut in the front surface of the candy coating of the M and M and the insides are scooped out. This leaves the lens capsule in place. The new lens is placed where the old lens was, inside of the lens capsule through the opening that was made in the front of the lens capsule (to remove the cataract). Intraocular lenses can be made of several different materials and come in a wide variety of designs.

How can an intraocular lens dislocate?

There are two ways that an intraocular lens can dislocate. One is when there is a defect or tear in the capsular bag holding the lens and the lens slips out of the capsular bag. (That is shown in the accompanying image) Another way the IOL can dislocate is if it stays in the capsular bag and the entire capsular bag destabilizes and looses its support and shifts. The first way is the most common. In-the-bag dislocation of an intraocular lens is less common and a little more difficult to address surgically. Posterior chamber intraocular lenses (IOLs) are
exquisitely engineered to provide excellent vision
when implanted into a stable capsule following
extracapsular cataract extraction. If the lens capsule
or the supporting lens zonules fail, and the IOL dislocates,
vision usually deteriorates.
Unfortunately, just as cars are not designed to be easily
fixed after crashing, IOLs are not designed to be easily
repositioned after dislocating.

Treatment choices: observation (no therapy)?

If the intraocular lens is only slightly decentered, a change in prescription glasses can compensate for the problem. Interestingly, if the intraocular lens is totally out of position and settled in the vitreous of the eye, sometimes it can be left in the eye and a seconday lens can be placed without removing the lens. Both of these options avoid the risk of removing or manipulating the dislocated lens. The risk of surgery (like an eye surgery) include infection, bleeding, retinal detachment and corneal damage.

Treatment choices: Lens exchange

Probably the most common procedure done for a dislocated intraocular lens is a lens exchange. The offending IOL is removed from the eye and a new lens is placed in the eye. If there is some capsule left in the eye that will support a larger IOL then a posterior chamber lens can be placed in the eye. If their is not capsular support adequate for a posterior chamber lens, then an anterior chamber IOL like the one in this photo can always be placed in front of the iris. In addition, there are a few useful techniques where a posterior chamber IOL can be placed into an eye without capsular support. A posterior chamber IOL can be clipped to the iris, sutured to the iris, sutured to the sclera or the haptics of the IOL can be tunnelled into the sclera. All of these options are reasonable depending on the state of the cornea, iris, and capsule.

Treatment choices: Iris suture fixation

If the dislocated IOL is in good shape and free of surrounding capsular debris, it can be captured in the pupil and sutured to the iris. This technique is demonstrated in one of the video's below. This technique only works well for dislocated IOLs that have haptics. There are other types of IOLs, like the crystalens IOL, that do not have haptics and cannot be sutured to the iris. The sutures holding the haptics of the IOL to the iris in the accompanying photograph are blue and can be seen where the arrows are pointing. The optic of the IOL is perfectly centered and not visible.

Video Iris fixation of dislocated IOL

This patient had cataract surgery and some of the fragments from the surgery dropped into the vitreous. They are removed and then the intra-ocular lens, which is not stable, is sutured to the iris for stability.

Treatment choices: Trans-scleral Suture Fixation

When there is inadequate capsular support to allow
simple repositioning of a dislocated IOL, sutures can be
used to secure the IOL in the visual axis. The IOL can be
sutured to the iris or the sclera. In cases
of an in-the-bag dislocated IOL or a plate-haptic dislocated
IOL, a transscleral 9-0 polypropylene fixation technique
is preferable.
The knots used to tie the transscleral sutures securing
the IOL present a vexing problem. If they are covered
with only conjunctiva and Tenon capsule, they usually
erode through the covering. Once exposed, the knots
irritate the eye and pose an increased risk of endophthalmitis.
The technique presented in this article and the accompanying
video obviates the need to make a scleral flap
or tunnel by using the needle on the 9-0 polypropylene
suture to bury the suture in the sclera. The knot
can then be rotated into the eye through a preplaced
23-gauge sclerotomy.

Video Trans-scleral Suture fixation of dislocated IOL

This is a novel technique to secure a dislocated intraocular lens using a 9-0 prolene suture that allows the suture and the knot to both be completely buried at the end of the surgery without the need to make a scleral tunnel.

This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. Through this site and linkages to other sites, The information provided in this site, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider.

IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY, YOU SHOULD IMMEDIATELY CALL 911 OR YOUR PHYSICIAN. If you believe you have any other health problem, or if you have any questions regarding your health or a medical condition, you should promptly consult your physician or other healthcare provider. Never disregard medical or professional advice, or delay seeking it, because of something you read on this site or a linked website. Never rely on information on this website in place of seeking professional medical advice. You should also ask your physician or other healthcare provider to assist you in interpreting any information in this Site or in the linked websites, or in applying the information to your individual case.

Medical information changes constantly. Therefore the information on this Site or on the linked websites should not be considered current, complete or exhaustive, nor should you rely on such information to recommend a course of treatment for you or any other individual. Reliance on any information provided on this Site or any linked websites is solely at your own risk.